Claims Specialist Lead

The University of Kansas Health System•Lenexa, KS

1d•Onsite

About The Position

The Claims Specialist Lead assists the Claims Manager and Claims Staff with claims issues. The role helps coordinate workload assignments, fills in for staff as needed, and troubleshoots questions when the Claims Manager is absent. The position complies with governmental and managed care rules and regulations and meets department goals, productivity standards, and quality standards. The Claims Specialist Lead works with team members on problem solving, training, and mentoring, and serves as a subject matter expert for internal and external customers in the department manager’s absence. The role monitors trends in insurance-company claims processing and technical issues with the claims clearing house, confirms receipt of daily billing files, researches and resolves claim rejections within designated timeframes, reports rejection trends or delays to management, and submits paper claims and supporting documentation as payers require. The employee must be able to perform the professional, clinical, and/or technical competencies of the assigned unit or department. Duties may vary by department or unit, and other duties may be assigned as required.

Requirements

High school graduate or GED.
Three or more years of experience in claims or insurance processing.

Nice To Haves

Associate degree in a related field of study from an accredited college or university.
Four or more years of Epic experience.

Responsibilities

Assist the Claims Manager and Claims Staff with claims issues.
Assist with coordinating the team’s workload.
Fill in for staff as needed and troubleshoot questions in the Claims Manager’s absence.
Work with team members on problem solving, training, and mentoring.
Act as a subject matter expert for internal and external customers in the department manager’s absence.
Observe and communicate trends in insurance-company claims processing or technical issues with the claims clearing house to the Claims Manager.
Confirm receipt of daily billing files by the claims clearing house.
Research and resolve claim rejections within designated timeframes.
Report claim rejection trends or delays to management.
Submit paper claims and supporting documentation as required by payers.
Comply with governmental and managed care rules and regulations and meet department goals, productivity standards, and quality standards.
Perform the professional, clinical, and/or technical competencies of the assigned unit or department.